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Beneficiary Notices Initiative (BNI)

BNI OVERVIEW

OBJECTIVE: It is an agency objective to improve agency-to-beneficiary communications in order to further beneficiary education and health promotion, and to facilitate access to and exercise of individual rights and protections. The use of beneficiary notices is one of CMS' best opportunities to achieve successful outreach to program beneficiaries. CMS directly touches the lives of millions of beneficiaries every day by its program notices to beneficiaries.

PURPOSE: The purpose of the CMS Beneficiary Notices Initiative [BNI] is to wed consumer rights and protections with effective beneficiary communication so that beneficiaries are given the opportunity to timely exercise their rights and protections in a well-informed manner. These rights and protections are both statutorily & regulatorily mandated, as well as by Executive Order, and are enunciated in various venues and formats, such as providers' Conditions of Participation, the President's Consumer Bill of Rights & Responsibilities, Privacy Act Statements, and statements of non-discrimination (the Civil Rights Act).

FEATURES:

BNI - improving notices to improve beneficiary communications:

	by furthering beneficiary education and health promotion
	by facilitating access to and exercise of individual rights and protections (notices are given to beneficiaries every day, in all physician, supplier, provider, and health plan settings)
	Since 1999, the agency, through its Beneficiary Notices Initiative, has been:

	formulating organizing principles and coherent communication plan strategy
	systematically revisiting and, as necessary, revising beneficiary notices

Through the BNI, CMS can:

	change the way it interacts with beneficiaries about rights and protections
	model the behavior of a prudent purchaser in today's health care market by drafting notices that go beyond simply complying with legal requirements

CMS has the opportunity to better serve its beneficiaries by:

	accurately informing beneficiaries as to viable choices
	providing the information necessary to exercise rights and protections
	encouraging the exercise of individual responsibilities, including becoming pro-active partners in one's own health care decisions and combating fraud and abuse

BNI NOTICES

Both MS Word files and Adobe Acrobat PDF files are furnished for most items. We recommend viewing notices in the PDF format, as it retains the appearance more accurately.

OASIS Privacy Notices (Home Health Agency Outcome and Assessment Information Set)

	OASIS Statement of Patient Privacy Rights / Privacy Act Statement - Health Care Records English MSWord file PDF file Spanish MSWord file PDF file
	OASIS Notice about Privacy for Patients Who Do Not Have Medicare or Medicaid Coverage English MSWord file PDF file Spanish MSWord file PDF file

Advance Beneficiary Notice [ABN], forms HCFA-R-131 & CMS-R-131
See the ABN Quick Reference Guide for more information and FAQs.

HCFA-R-131 is the model language version of the ABN which has been in use since 1988 and is still in use. The HCFA-R-131 may be modified by the user, following the guidance in Medicare Carriers Manual sections 7300.5.A and 7330.D.

	HCFA-R-131 (Model Language) MSWord file PDF file
	HCFA-R-131 Instructions MSWord file PDF file

CMS-R-131 is the form number for the new ABNs currently in clearance. There are two CMS-R-131 forms, the General Use form ("ABN-G") and the Laboratory Tests form ("ABN-L"). Both CMS-R-131 ABN forms will be standard forms which may not be modified. Both contain customizable boxes for the individual use requirements of users, following the guidance in the DRAFT Medicare Carriers Manual section 7310, currently in clearance. Currently, the CMS-R-131-G and CMS-R-131-L have been approved temporarily by OMB and may be used on a voluntary basis instead of the HCFA-R-131. When final OMB approval is obtained, the CMS-R-131-G and CMS-R-131-L will become mandatory.

	CMS-R-131-G (General Use) English MSWord file PDF file Spanish MSWord file PDF file
	CMS-R-131-L (Laboratory Tests) English MSWord file PDF file Spanish MSWord file PDF file
	DRAFT MCM Instructions--Section 7310 PDF file(471 K) MSWord zip file(48 K) MSWord file(187 K)

Home Health Advance Beneficiary Notice [HHABN], form HCFA-R-296
See the Home Health PPS Quick Reference Guide for more information and FAQs.

	HCFA-R-296 (2-page form) English MSWord file PDF file Spanish MSWord file PDF file
	HCFA-R-296 Instructions PM A-01-05 MSWord file PDF file PM A-01-30 MSWord file PDF file PM A-01-70 MSWord file PDF file

Medicare+Choice Denial Notices, form CMS-10003

	CMS-10003-NDP (Notice of Denial of Payment) MSWord file PDF file
	CMS-10003-NDP Instructions MSWord file PDF file
	CMS-10003-NDMC (Notice of Denial of Medical Coverage) MSWord file PDF file
	CMS-10003-NDMC Instructions MSWord file PDF file

Note: Some of the files on this page are available only in Adobe Portable Document Format (PDF). PDF files retain the rich formatting of printed documents. To view PDF files, you must have the Adobe Acrobat Reader (version 4 or higher). You can check here to see if you have the Acrobat Reader installed on your computer. If you do not already have the Acrobat Reader installed, please go to Adobe's Acrobat download page now.

Beneficiary Notices Initiative (BNI)

BNI OVERVIEW

BNI NOTICES

Send mail to martineu@umdnj.edu with questions or comments about this web site. Last modified: August 03, 2005

Send mail to martineu@umdnj.edu with questions or comments about this web site.
Last modified: August 03, 2005